<?xml version="1.0"?>

<!--
SPDX-FileCopyrightText: 2008-2026 Luis Falcón <falcon@gnuhealth.org>
SPDX-FileCopyrightText: 2011-2026 GNU Solidario <health@gnusolidario.org>

SPDX-License-Identifier: GPL-3.0-or-later
-->

<form>
    <label name="assessment"/>
    <field name="assessment"/>
    <label name="activity_and_participation"/>
    <field name="activity_and_participation"/>
    <label name="qualifier1"/>
    <field name="qualifier1"/>
    <label name="qualifier2"/>
    <field name="qualifier2"/>
</form>
